<!--
 * Copyright TLR Team, Inc. All Rights Reserved.
-->
<div class="tlr-assessment-container">
    <form class="form-horizontal">
        <div class="form-group">
            <div class="col-sm-12" style="border-bottom: 1px solid #BEBEBE; padding-bottom: 10px; font-size: 20px;">
                <label class="col-sm-5 control-label">11.社交、文化和休闲活动</label>
            </div>
        </div>
        <div class="form-group">
            <div class="col-sm-12" style="border-bottom: 1px solid #BEBEBE; padding-bottom: 10px; font-size: 16px;">
                <div style="display: block; padding: 10px;">
                    本章节关注对象与家人朋友保持联系以及与他人社交的事宜。同时也关注如去图书馆、购物、看电影、参加社区活动、去教堂或其他宗教场所等事宜
                </div>
            </div>
        </div>
        <div class="col-sm-12">
            <table class="table table-bordered" style="font-size: 16px;">
                <thead>
                    <tr>
                        <th>请在下列“我的意见”选项中选择一项</th>
                        <th>我的意见</th>
                        <th>评估人员意见</th>
                        <th>最终结果</th>
                    </tr>
                </thead>
                <tbody>
                    <tr>
                        <td>我很满足现状，不需任何协助</td>
                        <td> <input type="radio" name="optionsRadios11_myview" id="optionsRadios" value="0"  ng-model="assessment.socialCulturalLeisure.myview"></td>
                        <td> <input type="radio" name="optionsRadios11_assist" id="optionsRadios" value="0"   ng-model="assessment.socialCulturalLeisure.assessorview"></td>
                        <td> <input type="radio" name="optionsRadios11_descision" id="optionsRadios" value="0" ng-model="assessment.socialCulturalLeisure.agreeddecision"></td>
                    </tr>
                    <tr>
                        <td>我有一些朋友和社会交往。我需要有人来提醒或鼓励我与他们保持联络/参加群体活动</td>
                        <td> <input type="radio" name="optionsRadios11_myview" id="optionsRadios" value="1"  ng-model="assessment.socialCulturalLeisure.myview"></td>
                        <td> <input type="radio" name="optionsRadios11_assist" id="optionsRadios" value="1"   ng-model="assessment.socialCulturalLeisure.assessorview"></td>
                        <td> <input type="radio" name="optionsRadios11_descision" id="optionsRadios" value="1" ng-model="assessment.socialCulturalLeisure.agreeddecision"></td>
                    </tr>
                    <tr>
                        <td>我每周需要几次帮助，方便我与朋友联系/参加社区活动</td>
                        <td> <input type="radio" name="optionsRadios11_myview" id="optionsRadios" value="2"  ng-model="assessment.socialCulturalLeisure.myview"></td>
                        <td> <input type="radio" name="optionsRadios11_assist" id="optionsRadios" value="2"   ng-model="assessment.socialCulturalLeisure.assessorview"></td>
                        <td> <input type="radio" name="optionsRadios11_descision" id="optionsRadios" value="2" ng-model="assessment.socialCulturalLeisure.agreeddecision"></td>
                    </tr>
                    <tr>
                        <td>我不常与人见面，经常需要帮助进行社交/参与社区活动</td>
                        <td> <input type="radio" name="optionsRadios11_myview" id="optionsRadios" value="3"  ng-model="assessment.socialCulturalLeisure.myview"></td>
                        <td> <input type="radio" name="optionsRadios11_assist" id="optionsRadios" value="3"   ng-model="assessment.socialCulturalLeisure.assessorview"></td>
                        <td> <input type="radio" name="optionsRadios11_descision" id="optionsRadios" value="3" ng-model="assessment.socialCulturalLeisure.agreeddecision"></td>
                    </tr>
                    <tr>
                        <td>我有时需要帮助进行购物</td>
                        <td> <input type="radio" name="optionsRadios11_myview" id="optionsRadios" value="4"  ng-model="assessment.socialCulturalLeisure.myview"></td>
                        <td> <input type="radio" name="optionsRadios11_assist" id="optionsRadios" value="4"   ng-model="assessment.socialCulturalLeisure.assessorview"></td>
                        <td> <input type="radio" name="optionsRadios11_descision" id="optionsRadios" value="4" ng-model="assessment.socialCulturalLeisure.agreeddecision"></td>
                    </tr>
                    <tr>
                        <td>我有时需要帮助进行房间清洁</td>
                        <td> <input type="radio" name="optionsRadios11_myview" id="optionsRadios" value="5"  ng-model="assessment.socialCulturalLeisure.myview"></td>
                        <td> <input type="radio" name="optionsRadios11_assist" id="optionsRadios" value="5"   ng-model="assessment.socialCulturalLeisure.assessorview"></td>
                        <td> <input type="radio" name="optionsRadios11_descision" id="optionsRadios" value="5" ng-model="assessment.socialCulturalLeisure.agreeddecision"></td>
                    </tr>
                    <tr>
                        <td>我有时需要帮助进行书写、填表和/或管理财务</td>
                        <td> <input type="radio" name="optionsRadios11_myview" id="optionsRadios" value="6"  ng-model="assessment.socialCulturalLeisure.myview"></td>
                        <td> <input type="radio" name="optionsRadios11_assist" id="optionsRadios" value="6"   ng-model="assessment.socialCulturalLeisure.assessorview"></td>
                        <td> <input type="radio" name="optionsRadios11_descision" id="optionsRadios" value="6" ng-model="assessment.socialCulturalLeisure.agreeddecision"></td>
                    </tr>
                    <tr>
                        <td>我有时需要帮助洗衣和/或更换床单</td>
                        <td> <input type="radio" name="optionsRadios11_myview" id="optionsRadios" value="7"  ng-model="assessment.socialCulturalLeisure.myview"></td>
                        <td> <input type="radio" name="optionsRadios11_assist" id="optionsRadios" value="7"   ng-model="assessment.socialCulturalLeisure.assessorview"></td>
                        <td> <input type="radio" name="optionsRadios11_descision" id="optionsRadios" value="7" ng-model="assessment.socialCulturalLeisure.agreeddecision"></td>
                    </tr>
                    <tr>
                        <td>我定期需要帮助进行购物</td>
                        <td> <input type="radio" name="optionsRadios11_myview" id="optionsRadios" value="8"  ng-model="assessment.socialCulturalLeisure.myview"></td>
                        <td> <input type="radio" name="optionsRadios11_assist" id="optionsRadios" value="8"   ng-model="assessment.socialCulturalLeisure.assessorview"></td>
                        <td> <input type="radio" name="optionsRadios11_descision" id="optionsRadios" value="8" ng-model="assessment.socialCulturalLeisure.agreeddecision"></td>
                    </tr>
                    <tr>
                        <td>我定期需要帮助进行房间清洁</td>
                        <td> <input type="radio" name="optionsRadios11_myview" id="optionsRadios" value="9"  ng-model="assessment.socialCulturalLeisure.myview"></td>
                        <td> <input type="radio" name="optionsRadios11_assist" id="optionsRadios" value="9"   ng-model="assessment.socialCulturalLeisure.assessorview"></td>
                        <td> <input type="radio" name="optionsRadios11_descision" id="optionsRadios" value="9" ng-model="assessment.socialCulturalLeisure.agreeddecision"></td>
                    </tr>
                    <tr>
                        <td>我定期需要帮助进行书写、填表和/或管理财务</td>
                        <td> <input type="radio" name="optionsRadios11_myview" id="optionsRadios" value="10"  ng-model="assessment.socialCulturalLeisure.myview"></td>
                        <td> <input type="radio" name="optionsRadios11_assist" id="optionsRadios" value="10"   ng-model="assessment.socialCulturalLeisure.assessorview"></td>
                        <td> <input type="radio" name="optionsRadios11_descision" id="optionsRadios" value="10" ng-model="assessment.socialCulturalLeisure.agreeddecision"></td>
                    </tr>
                    <tr>
                        <td>我定期需要帮助洗衣和/或更换床单</td>
                        <td> <input type="radio" name="optionsRadios11_myview" id="optionsRadios" value="11"  ng-model="assessment.socialCulturalLeisure.myview"></td>
                        <td> <input type="radio" name="optionsRadios11_assist" id="optionsRadios" value="11"   ng-model="assessment.socialCulturalLeisure.assessorview"></td>
                        <td> <input type="radio" name="optionsRadios11_descision" id="optionsRadios" value="11" ng-model="assessment.socialCulturalLeisure.agreeddecision"></td>
                    </tr>
                    <tr>
                        <td>我总是需要帮助进行购物</td>
                        <td> <input type="radio" name="optionsRadios11_myview" id="optionsRadios" value="12"  ng-model="assessment.socialCulturalLeisure.myview"></td>
                        <td> <input type="radio" name="optionsRadios11_assist" id="optionsRadios" value="12"   ng-model="assessment.socialCulturalLeisure.assessorview"></td>
                        <td> <input type="radio" name="optionsRadios11_descision" id="optionsRadios" value="12" ng-model="assessment.socialCulturalLeisure.agreeddecision"></td>
                    </tr>
                    <tr>
                        <td>我总是需要帮助进行房间清洁</td>
                        <td> <input type="radio" name="optionsRadios11_myview" id="optionsRadios" value="13"  ng-model="assessment.socialCulturalLeisure.myview"></td>
                        <td> <input type="radio" name="optionsRadios11_assist" id="optionsRadios" value="13"   ng-model="assessment.socialCulturalLeisure.assessorview"></td>
                        <td> <input type="radio" name="optionsRadios11_descision" id="optionsRadios" value="13" ng-model="assessment.socialCulturalLeisure.agreeddecision"></td>
                    </tr>
                    <tr>
                        <td>我总是需要帮助进行书写、填表和/或管理财务</td>
                        <td> <input type="radio" name="optionsRadios11_myview" id="optionsRadios" value="14"  ng-model="assessment.socialCulturalLeisure.myview"></td>
                        <td> <input type="radio" name="optionsRadios11_assist" id="optionsRadios" value="14"   ng-model="assessment.socialCulturalLeisure.assessorview"></td>
                        <td> <input type="radio" name="optionsRadios11_descision" id="optionsRadios" value="14" ng-model="assessment.socialCulturalLeisure.agreeddecision"></td>
                    </tr>
                    <tr>
                        <td>我总是需要帮助进行洗衣、整理床单</td>
                        <td> <input type="radio" name="optionsRadios11_myview" id="optionsRadios" value="15"  ng-model="assessment.socialCulturalLeisure.myview"></td>
                        <td> <input type="radio" name="optionsRadios11_assist" id="optionsRadios" value="15"   ng-model="assessment.socialCulturalLeisure.assessorview"></td>
                        <td> <input type="radio" name="optionsRadios11_descision" id="optionsRadios" value="15" ng-model="assessment.socialCulturalLeisure.agreeddecision"></td>
                    </tr>
                </tbody>
            </table>
            <div class="form-group">
                <label for="exampleInputEmail1" style="font-size: 16px;">社交、文化和休闲活动 记录</label>
                <textarea class="form-control" rows="5"  ng-model="assessment.socialCulturalLeisure.notes"></textarea>
            </div>
            <div class="form-group">
                <div class="col-sm-9">
                    <input class="btn btn-default" style="float: right;" type="button" value="下一页" ng-click="nextPage(12)">
                    <input class="btn btn-default" style="float: right; margin-right: 30px;" type="button" value="上一页" ng-click="prevPage(10)">
                </div>
            </div>
        </div>
    </form>
</div>
